CD4/CD8 T-cell ratio predicts HIV infection in infants: The National Heart, Lung, and Blood Institute (PC2)-C-2 Study

• Type of Material: Article
• Authors: William T. Shearer, Baylor College of Medicine; Savita Pahwa, University of Miami; Jennifer S. Read, National Institute of Child Health and Human Development; Jian Chen, Emory University; Sameera R. Wijayawardana, Emory University; Paul Palumbo, Dartmouth College; Elaine J. Abrams, Columbia University; Steven Nesheim, Emory University; Wanrong Yin, Clinical Trials & Survey Corporation; Bruce Thompson, Clinical Trials & Survey Corporation; Kirk Easley, Emory University
• Language: English
• Date: 2007-12-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2007 American Academy of Allergy, Asthma & Immunology.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jaci.2007.08.037
• Title of Journal or Parent Work: Journal of Allergy and Clinical Immunology
• ISSN: 0091-6749
• Volume: 120
• Issue: 6
• Start Page: 1449
• End Page: 1456
• Grant/Funding Information: Supported by National Institutes of Health grants and contracts HL96040, HL079533, HL72705, AI27551, AI36211, HD41983, RR0188, and AI41089; the Emory Center for AIDS Research (P30 A1050409); the Pediatric Research and Education Fund, Baylor College of Medicine; and the David Fund, Pediatrics AIDS Fund, and Immunology Research Fund, Texas Children’s Hospital.
• Keywords: HIV infection; TRANSMISSION; THERAPY; mother-to-child transmission of HIV; Allergy; CD4/CD8 T-cell ratio; CHILDREN; MORTALITY; Life Sciences & Biomedicine; Immunology; AIDS; Science & Technology; AGE
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health; Health Sciences, Pathology

Abstract

Background: In resource-poor regions of the world, HIV virologic testing is not available. Objective: We sought to evaluate the diagnostic usefulness of the CD4/CD8 T-cell ratio in predicting HIV infection in infants. Methods: Data from the 3- and 9-month visits for non–breastfed infants born to HIV-infected mothers enrolled (1990–1994) in the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study (mother-to-child transmission of HIV, 17%) were analyzed. Data from the 3-month visit for infants enrolled (1985–1996) in the Perinatal AIDS Collaborative Transmission Study (mother-to-child transmission of HIV, 18%) were used for validation. Results: At 3 months of age, data were available on 79 HIV-infected and 409 uninfected non–breast-fed infants in the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study. The area under the curve (AUC) of the receiver operating characteristic curve at 3 months was higher for the CD4/CD8 ratio compared with the CD4+ T-cell count (AUC, 0.83 and 0.75; P = .03). The mean CD4/CD8 ratio at the 3-month visit was 1.7 for HIV-infected infants and 3.0 for uninfected infants. A CD4/CD8 ratio of 2.4 at 3 months of age was almost 2.5 times more likely to occur in an HIV-infected infant compared with an uninfected infant (test sensitivity, 81%; posttest probability of HIV, 33%). Model performance in the Centers for Disease Control and Prevention Perinatal AIDS Collaborative Transmission Study validation test (224 HIV-infected and 1015 uninfected 3-month-old infants) was equally good (AUC, 0.78 for CD4/CD8 ratio). Conclusion: The CD4/CD8 T-cell ratio is a more sensitive predictor of HIV infection in infants than the CD4+ T-cell count.